Criteria
Coverage is subject to the specific terms of the member's benefit plan.
Patient lifts
may be considered medically necessary
when the individual's condition is such that periodic movement is necessary to effect improvement or to arrest/retard deterioration in his condition.
Patient lifts may be considered medically necessary DME:
-
If one of the following conditions is met;
and
- If transfer between bed and a chair, wheelchair, or commode requires the assistance of more than one (1) person and, without the use of a lift; the member would be bed-confined.
The following are examples of medically necessary conditions, but this is not all inclusive list:
- Advanced degenerative muscular diseases such as: muscular dystrophy
- Bilateral amputee
- Coma
- Contractures (rigidity)
- Degenerative joint disease
- Fracture pelvis or spine
- Hip spica or body cast
- Paralysis (hemiplegia, paraplegia, quadriplegia, hemiparesis)
- Rheumatoid arthritis
- Severe congestive heart failure
- Severe neurological disorders such as: multiple sclerosis, amyotrophic lateral sclerosis, syringomyelia, spinal cord tumors, advanced cerebellar degeneration
- Stroke (CVA or cerebral vascular accident)
When the individual's condition is other than one listed above, the claim should be referred for medical review to determine medical necessity for the lift.
Patient lifts
not meeting the criteria as indicated in this policy
are considered
not medically necessary.
Procedure Codes
